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The Cost of Hope Hardcover – 5 Jun 2012
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About the Author
Amanda Bennett is an executive editor at Bloomberg News, directing special projects and investigations, and was the co-chair of the Pulitzer Prize Board. She formerly served as editor of The Philadelphia Inquirer, editor of the Herald-Leader (Lexington, Kentucky), managing editor of The Oregonian (Portland, Oregon), and Atlanta bureau chief (among numerous other posts) at The Wall Street Journal. In 1997, Bennett shared the Pulitzer Prize for national reporting with her Journal colleagues, and in 2001 she led an Oregonian team to a Pulitzer for public service. Her previous books include In Memoriam (1997, with Terence B. Foley), The Man Who Stayed Behind (1993, with Sidney Rittenberg), and The Death of the Organization Man (1990).
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Most helpful customer reviews on Amazon.com
Anyway, the reason the book held so much interest for me was not the point that the author tried to make with respect to healthcare costs--in fact, in this respect the book was rather weak. Articles by Atul Gwande in the New Yorker do a much better job of analyzing healthcare costs overall, and I commend them to you. In particular, his article on McAllen, TX, is highly informative for those who believe that "free markets" will cure the healthcare system of its ills.
The real reason I found this book so fascinating is that I am an oncology nurse, and I see everyday something that the author talks about--that is, people in the very last stages of life (and their families) who are in complete denial about what is happening. It is astonishing to me (over and over) how frequently people cannot see what is in front of their eyes. And it is also astonishing to me how much "healthcare" is provided to those who have absolutely no hope of surviving, mainly because no one wants to admit that what is happening is happening.
I don't believe there is a simple answer to this problem, but I think that we, as a society, need to have a conversation about what we are willing to pay for and what we aren't (but then we are accused of supporting "death panels"). You know what? There is such a thing as too much "care," and sometimes it would be helpful to everyone if there were a third-party, or a social rule, in which someone, or some entity stepped in and said, "enough is enough," and you now have to pay. Sure, the rich could pay for extra care, but when that extra care is futile, it is not contributing to health disparities. Preventive care that is not accessible to everyone is what contributes to health disparities.
People think there are no limits to healthcare, that somehow the next treatment or the next medicine will fix the problem, but the fact is that all of us must die. Somehow we all have to come to terms with that, but this book illustrates how hard that can be.
Amanda Bennett and her husband Terence Foley are in a great position to face cancer: they're bright and well-educated, with good incomes and excellent health insurance. Yet even though the health care system lavishes an expensive if badly coordinated barrage of tests, doctors visits and chemo drugs on Terence, in the end it fails them. Not because Terence dies -- that was in the cards -- but because part of the "cost of hope" is that no doctor who really knows Amanda or Terence ever sits down with them to help them prepare a Plan B --hospice, palliative care, conscious goodbyes, weighing prolonging suffering vs. a few additional weeks of life -- or none. And Plan B, after all, is what patients with many cancers ultimately need.
I found myself wondering how long Terence would have survived if, after his cancerous kidney was removed, he'd simply had no extra treatment at all.
The financial details of the cost of care, the gimlet look at clinical trials, and other telling bits of investigative journalism paint a portrait of a national scandal. But the tone is balanced, wondering, open, and full of love for her husband. There are no unnecessary words. I cried at the end and was sorry she didn't have the chance for a more conscious goodbye.